Point-of-Care Pricing Toolkit
Toolkit to help you collect payment from patients before they walk out the door
Did you know that 48% percent of better-performing practices collect more than 90% of patient payments at the time of service?
See decreased accounts receivable and more cash flow in your practice immediately by collecting payment from patients at the time of service—before they walk out the door. Make the most of the information that is now available from an eligibility benefit inquiry and response transactions (eligibility request and response) to help you determine a patient’s financial responsibility and receive payment from them at the time of service—reducing billing and back-end collection costs. Your practice can stay financially viable by collecting what patients owe at the time of service.
By making a decision to use point-of-care pricing (POC) to collect from patients at the time of service, your practice can:
- Save money that would be otherwise spent tracking and writing off bad patient debt;
- Increase cash flow, and reduce administrative costs and burdens, by obtaining eligibility verification and other crucial information upfront.
Access the following archived webinars to help your practie learn how to collect payment from patients at the point of care.
- “Electronic eligibility request and response: Much more than ‘Yes, the patient is eligible.” – Also access a toolkit to help you learn how to use electronic eligibility verification.
- “Helping patients understand financial responsibility at the time of service, part one.”
- “Helping patients understand financial responsibility at the time of service, part two: What to do when you encounter bumps in the road”
Although almost all patients have some responsibility to pay for the medical services they receive, patient responsibility may be overlooked at the time of the visit. Most patients have, at minimum, a co-payment due at the time of an appointment, and many patients have other financial obligations, as well.
View steps that your practice can take to successfully collect accurate payments from patients at the point of care.
POC pricing and collection at the time of service is possible - Learn how!
As deductibles and coinsurance amounts continue to increase, so has uncollected patient financial responsibility, resulting in physician practice bad debt. Avoid lost revenue by receiving potentially greater patient payment at the time of service.
The cost of collection services can vary from 20% to 50%, depending on the volume of accounts and revenue recovered. Here are some more noteworthy figures:
- Nineteen percent of all health insurance was high-deductible health plans (HDHPs) in 2012, and it is likely this number will keep increasing as the percentage of employers offering these plans has been growing quickly, with 31% of employers offering such plans in 2012.  Of particular concern to physicians, HDHPs are disproportionately found among lower income workers for whom health care debt may be a bigger challenge.
- Based on historical averages, your practice will recover just $15.77 for every $100 owed once patient’s bad debt is turned over to collections.  Using information from the electronic eligibility benefit inquiry and response transactions with the Health Insurance Portability and Accountability Act (HIPAA)-mandated operating rules can help your practice provide point-of-care pricing in order to collect payments from patients at time of service and lower your back-end collection cost.
- Reminding patients to pay their bills by creating and mailing statements costs physician practices between $5 and $14 per patient. If a patient does not pay his or her bill within three statements, the likelihood of a practice receiving payment diminishes greatly. Collecting from patients at the time of service helps ensure payment.
From a cash flow perspective, if the average amount due from a patient at the time of their visit is $110, and each physician in your office sees 20 patients each day, you could miss out on collecting $2,200 per physician each day
Avoid lost revenue and increase your cash flow by incorporating patient payment at the time of service into your practice today.
 Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2012
 Margolis J, Pope C. Perspective on patient payments. MGMA Connexion. April 2010: 37.
 Margolis J, Pope C. Perspective on patient payments. MGMA Connexion. April 2010: 39.
Everyone involved in patient service—from the front office staff to physicians and billing staff—plays an essential role in contributing to cash flow. Before providing point-of-care pricing to patients, it is important to consider the value that collecting at the time of service brings to your claims revenue cycle. Listed below are metrics to consider prior to establishing a process for providing point-of-care pricing to your patients and collecting payments at the time of service.
- Patient responsibility as a percentage of total revenue
- Percentage of total payments received from patients as a percentage of total patient responsibility or percentage of patient bad debt
- Accuracy of point-of-care price estimates
- Cost to collect payments at the time of service
- Cost to mail statements and reminders
- Cost of back-end collections
- Patient satisfaction
- Staff satisfaction
- Physician satisfaction
- Return on investment (ROI) for instituting POC pricing and collecting payments at the time of service
Interested in learning more about rapid process improvement? Learn about effective ways to improve your practice while enhancing your claims revenue cycle. You will be glad you did!
Does your practice management software system (PMS) offer what your practice needs to collect at the time of service? Are you able to determine point-of-care price estimates electronically for your patients? Does your PMS allow you to post and reconcile payments made by patients at the time of service, prior to billing the health insurer? Are you able to electronically submit your claims on the same day of service?
If you answer “no” to one or more of these questions, then your PMS does not offer all of the capabilities you need to perform your point-of-care collections in your practice. Reach out to your PMS vendor, billing service and clearinghouse to discuss options and product functionality that help your practice collect payments at the time of service successfully. If your PMS does not currently provide this functionality, many health insurers provide access to point-of-care pricing estimators. Visit www.ama-assn.org/go/payerpolicies to access online resources.
Access the AMA and Medical Group Management Association’s “Selecting a practice management system toolkit” to learn more.
Learn what physician practices from across the country are saying about how they’re using electronic eligibility verification to collect from patients at the time of service—and how you can do the same in your practice. Join the AMA Practice Efficiency and Management LinkedIn Group to learn more about having a “paperless practice,” and ask your own questions! Physicians, practice staff, consultants and other health care partners are invited to join this group. If you don’t have a LinkedIn account, you can open one for free here.
This toolkit is a part of the AMA’s “Heal the Claims Process” ™ campaign, which aims to help the physician practice reduce the cost of claims processing from as much as 14% to just 1% of practice revenue. Learn more about the campaign, access additional resources to help your practice streamline claims processing, and show your commitment to claims processing efficiencies. Add your name to the list of those who have pledged to participate in the campaign.
View the sample template letter (for AMA members) directed to health insurers and other payers for inquiries concerning the terms & conditions of your insurance contracts as they relate to your right to provide point-of-care (POC) pricing and collect payments at the time of care. As a benefit of membership, AMA members can download this sample template letter as a Word file to modify and customize in their practices.